Care Home: Stanton Nursing Home

What the care home does well We looked at the pre-admission assessment that had been completed for one person who had not lived at the home for very long. The assessment was detailed and informative and provided a very clear picture of the resident`s needs. This assessment was used as a basis for care planning documentation. A mental capacity assessment is undertaken so that care staff are aware of each residents ability to make decisions about differing aspects of their daily life. We looked at the care planning documentation that had been prepared for the same resident and for two others, and judged that care planning processes are robust, residents individual care needs will be identified and a plan of care devised in respect of how those needs are to be met. Residents are cared for with a person-centred approach to their needs, and they are treated as unique individuals. During our visit we observed resident being cared for in a respectful manner, with positive and meaningful interactions with the staff. We looked at medication systems and checked the procedures in place to monitor stock levels. These have recently been strengthened to ensure more robust checking procedures are in place. This action has been taken because of some discrepancies found with liquid medications being used. Appropriate actions have been taken by the home. We asked about how the pain relief is managed for people with dementia and were told that staff would administer pain relief as prescribed and monitor residents comfort, as some are unable to verbally express when they are in pain. Further medical advice would be sought as and when needed. During the course of the visit residents appeared to be well occupied and were content and moving around the home independently. An activity organiser was present who was arranging an aromatherapy and hand massage session. They told us they visit the hometwice a week and do a number of different activities. Other activities are also arranged throughout the week. Staff presence in the main communal areas was evident throughout the visit. We looked at the complaints log and were assured that any concens or complaints residents or their families may have will be appropriately addressed. We saw that the home had raised concerns with the hospital where discharge arrangments for one resident had not been satisfactory. We gained assurance that residents will be listened to and any concerns will be acted upon. We looked around the home. Mr and Mrs Larkin told us that they have had a recent infection control audit and had fully implemented all the recommendations made. This is so that they can declare full compliance with cleanliness and infection control standards, and is commendable. Since the last full inspection, the home environment has benefitted from extensive refurbishment and upgrading. Toilet rooms have been made easily identifiable - the doors have been painted red and signage displayed in order to make it easier for people with dementia to locate the faciltities independently. The provision of a new wet room on the ground floor has greatly improved showering facilities for the residents. The corridors and hallways have been brightened up and new flooring laid. We saw all the bedrooms, bedrooms are based on all three floors of the home. One of the double bedrooms was in the process of being fully refurbished. Residents and their families are encouraged to `make their bedroom their own` and bring in small items of furniture and personal items - we noted a varying degree of personalisation of rooms. All bedroom doors are painted different colours to aid residents in locating their own bedroom, and memory boxes are displayed on the walls outside of bedrooms - families are asked to bring in items of interest for the resident to aid interaction. Building works are in progress to provide additional communal facilities. A full length conservatory along the back of the house will enable residents to move in and out of the gardens independently and will provide a circular walking route so that they can wander and explore their environment in safety. All the changes that have been made have been based on good practice guidelines for people who have a dementia, and enable residents to retain any skills of independence they may still have. We have previously asked the home to ensure that the staff team had received first aid training. We checked a number of staff files and verified that staff have received this training. Mrs Samantha Wyatt is the registered manager for this service. She is a qualified mental health nurse and has a range of relevant experience in the care of older people, mental health care and care of people with dementia. What the care home could do better: As part of care planning documentation, the home records residents end of life wishes. These are however recorded as relatives wishes and there should be better recording about the discussion and how decisions were reached. Decisions about residents ongoing medical treatment, in the event of a sudden illness, are being wrongly recorded. `Do not resuscitate` decisions can only be made by the residents GP in consultation with the resident where possible, family or other representatives and advocates. The home need to retain evidence of these discussions.A number of quilts we saw, despite being clean, were damaged and needed to be replaced. This was discussed with Mr and Mrs Larkin during the inspection. Random inspection report Care homes for older people Name: Address: Stanton Nursing Home 8 Queens Road Weston Super Mare North Somerset BS23 2LQ two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Vanessa Carter Date: 0 8 0 6 2 0 1 0 Information about the care home Name of care home: Address: Stanton Nursing Home 8 Queens Road Weston Super Mare North Somerset BS23 2LQ 01934625640 F/P01934625640 tessa@larkinfamily.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Samantha Jane Bruford Wyatt Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Teresa Larkin,Mr Charles Larkin care home 26 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: 26 The maximum number of service users who can be accommodated is 26. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Dementia (Code DE) Date of last inspection Brief description of the care home Stanton Nursing Home is registered with the Care Quality Commission (CQC) to provide nursing care for up to 26 people. The owners have another care home called Heathwood and this provides a service for people who have personal care needs only. Stanton is a converted Victorian Property situated on the quiet Weston hillside close to Care Homes for Older People Page 2 of 9 1 1 0 6 2 0 0 9 Brief description of the care home town, overlooking Grove Park and on a bus route. The home specialises in the dementia condition in the over 60s. The home has been adapted for use whilst retaining many original features creating a homely, safe, comfortable environment. There are front and rear gardens for resident use and most recently there is a new conservatory which has created an internal walking loop and unrestricted access to our rear secure garden, also with a walking loop. All other communal areas are modern spacious and have sympathetically been adapted for the category. A modern lift serves all areas of the home. Details regarding the service can be obtained from the home manager or owners, along with information about the fees. Care Homes for Older People Page 3 of 9 What we found: We have completed an unannounced short inspection of Stanton Nursing Home as part of our planned inspection programme. The last full inspection of this service was undertaken in June 2008 and at that time, our overall judgement about the quality of the service provided for the people who lived in the home was that they received a good quality service. We did an annual service review in June 2009 and based upon the information in the annual quality assurance assessment (AQAA), submitted by the owners, and completed survey forms we received back from residents/relatives, health and social care professionals,we concluded that residents were still receiving a good service. For this inspection we have looked at some of the home records, we have looked around the home and seen the changes to the environment that have been made since the last inspection. We have spoken to a number of staff who work in the home, a number of residents who live there and we have observed how the staff interact with those they are looking after. The registered manager was not present for the inspection. Mr and Mrs Larkin were present along with the staff team and the manager from Heathwood. What the care home does well: We looked at the pre-admission assessment that had been completed for one person who had not lived at the home for very long. The assessment was detailed and informative and provided a very clear picture of the residents needs. This assessment was used as a basis for care planning documentation. A mental capacity assessment is undertaken so that care staff are aware of each residents ability to make decisions about differing aspects of their daily life. We looked at the care planning documentation that had been prepared for the same resident and for two others, and judged that care planning processes are robust, residents individual care needs will be identified and a plan of care devised in respect of how those needs are to be met. Residents are cared for with a person-centred approach to their needs, and they are treated as unique individuals. During our visit we observed resident being cared for in a respectful manner, with positive and meaningful interactions with the staff. We looked at medication systems and checked the procedures in place to monitor stock levels. These have recently been strengthened to ensure more robust checking procedures are in place. This action has been taken because of some discrepancies found with liquid medications being used. Appropriate actions have been taken by the home. We asked about how the pain relief is managed for people with dementia and were told that staff would administer pain relief as prescribed and monitor residents comfort, as some are unable to verbally express when they are in pain. Further medical advice would be sought as and when needed. During the course of the visit residents appeared to be well occupied and were content and moving around the home independently. An activity organiser was present who was arranging an aromatherapy and hand massage session. They told us they visit the home Care Homes for Older People Page 4 of 9 twice a week and do a number of different activities. Other activities are also arranged throughout the week. Staff presence in the main communal areas was evident throughout the visit. We looked at the complaints log and were assured that any concens or complaints residents or their families may have will be appropriately addressed. We saw that the home had raised concerns with the hospital where discharge arrangments for one resident had not been satisfactory. We gained assurance that residents will be listened to and any concerns will be acted upon. We looked around the home. Mr and Mrs Larkin told us that they have had a recent infection control audit and had fully implemented all the recommendations made. This is so that they can declare full compliance with cleanliness and infection control standards, and is commendable. Since the last full inspection, the home environment has benefitted from extensive refurbishment and upgrading. Toilet rooms have been made easily identifiable - the doors have been painted red and signage displayed in order to make it easier for people with dementia to locate the faciltities independently. The provision of a new wet room on the ground floor has greatly improved showering facilities for the residents. The corridors and hallways have been brightened up and new flooring laid. We saw all the bedrooms, bedrooms are based on all three floors of the home. One of the double bedrooms was in the process of being fully refurbished. Residents and their families are encouraged to make their bedroom their own and bring in small items of furniture and personal items - we noted a varying degree of personalisation of rooms. All bedroom doors are painted different colours to aid residents in locating their own bedroom, and memory boxes are displayed on the walls outside of bedrooms - families are asked to bring in items of interest for the resident to aid interaction. Building works are in progress to provide additional communal facilities. A full length conservatory along the back of the house will enable residents to move in and out of the gardens independently and will provide a circular walking route so that they can wander and explore their environment in safety. All the changes that have been made have been based on good practice guidelines for people who have a dementia, and enable residents to retain any skills of independence they may still have. We have previously asked the home to ensure that the staff team had received first aid training. We checked a number of staff files and verified that staff have received this training. Mrs Samantha Wyatt is the registered manager for this service. She is a qualified mental health nurse and has a range of relevant experience in the care of older people, mental health care and care of people with dementia. What they could do better: As part of care planning documentation, the home records residents end of life wishes. These are however recorded as relatives wishes and there should be better recording about the discussion and how decisions were reached. Decisions about residents ongoing medical treatment, in the event of a sudden illness, are being wrongly recorded. Do not resuscitate decisions can only be made by the residents GP in consultation with the resident where possible, family or other representatives and advocates. The home need to retain evidence of these discussions. Care Homes for Older People Page 5 of 9 A number of quilts we saw, despite being clean, were damaged and needed to be replaced. This was discussed with Mr and Mrs Larkin during the inspection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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